Yetwin Alexis K, Mahrer Nicole E, John Cindy, Gold Jeffrey I
Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, USA; University of Southern California University Center of Excellence for Developmental Disabilities, Children's Hospital Los Angeles, USA.
University of Southern California University Center of Excellence for Developmental Disabilities, Children's Hospital Los Angeles, USA.
J Pediatr Nurs. 2018 May-Jun;40:7-13. doi: 10.1016/j.pedn.2018.02.003. Epub 2018 Feb 14.
Chronic pain is a complex and debilitating chronic health condition that negatively impacts a child's daily function. Previous investigations of coping behaviors in youth with chronic illness have suggested that secondary control/accommodative coping may be more adaptive than primary control/active coping or disengagement/passive coping. However, studies have not considered how pain intensity may change the effect of various coping strategies on functioning in this pediatric population. The current study examines how coping strategies relate to health-related quality of life (HRQOL) in youth with chronic pain at various levels of pain intensity.
Sixty-five children and adolescents, aged 8-18 (77% female: M=13.6years, SD=2.64) were recruited from a pediatric pain management clinic at an urban children's hospital. The Response to Stress Questionnaire examined coping behaviors of participants. The PedsQL 4.0 Generic Core Scales assessed HRQOL and a 10-cm Visual Analog Scale measured pain intensity.
Primary control engagement coping had a significant main effect to predict higher HRQOL. There was a significant interaction between secondary control engagement coping and pain, and a marginal interaction between disengagement coping and pain. Specifically, secondary control engagement coping significantly related to higher HRQOL when pain was low and disengagement coping marginally related to higher HRQOL when pain was high.
Findings suggest that the effectiveness of specific coping strategies may vary depending on a child's level of pain.
These findings suggest that clinicians (e.g., nurses, psychologists) use a more tailored approach when recommending interventions for managing chronic pain.
慢性疼痛是一种复杂且使人衰弱的慢性健康状况，会对儿童的日常功能产生负面影响。先前对患有慢性疾病的青少年应对行为的调查表明，二级控制/适应性应对可能比一级控制/积极应对或脱离/消极应对更具适应性。然而，研究尚未考虑疼痛强度如何改变各种应对策略对该儿科人群功能的影响。本研究考察了在不同疼痛强度水平下，应对策略与患有慢性疼痛的青少年健康相关生活质量（HRQOL）之间的关系。
从一家城市儿童医院的儿科疼痛管理诊所招募了65名8至18岁的儿童和青少年（77%为女性；平均年龄M = 13.6岁，标准差SD = 2.64）。应激反应问卷用于考察参与者的应对行为。儿童生活质量量表4.0通用核心量表评估健康相关生活质量，10厘米视觉模拟量表测量疼痛强度。
一级控制参与应对在预测更高的健康相关生活质量方面有显著的主效应。二级控制参与应对与疼痛之间存在显著的交互作用，脱离应对与疼痛之间存在边缘交互作用。具体而言，当疼痛程度较低时，二级控制参与应对与更高的健康相关生活质量显著相关；当疼痛程度较高时，脱离应对与更高的健康相关生活质量存在边缘相关。
研究结果表明，特定应对策略的有效性可能因儿童的疼痛程度而异。
这些研究结果表明，临床医生（如护士、心理学家）在推荐管理慢性疼痛的干预措施时应采用更具针对性的方法。
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